Marc Travis Nuttall, MD

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

68050182-1205 Issued in UT

Practice address

1055 N 500 W Ste 202
Provo, UT 84604-3305

Phone

(801) 374-2367

Fax

(801) 429-8015

NPI assigned

May 15, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hematology/Oncology

Education

Oregon Health Sciences University School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Castleview Hospital Hospital, Price, UT, CCN 460011
• Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
• Intermountain Health Sanpete Valley Hospital Hospital, Mount Pleasant, UT, CCN 461303
• American Fork Hospital Hospital, American Fork, UT, CCN 460023

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

Interoperability endpoints

• Direct secure messaging: marctnuttall@cuccu.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment Care Compare group NPD
• Revere Health PC

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Castleview Hospital LLC

  • Rural Acute Care Hospital
  • Price, UT
  • NPI 1417064205
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Provo, UT
  • NPI 1114025491
  Care Compare affiliation
• Ihc Health Services, Inc.

  • Critical Access Hospital
  • Mt Pleasant, UT
  • NPI 1407964398
  Care Compare affiliation
• Ihc Health Services, Inc.

  • Infusion Therapy Clinic/Center
  • Spanish Fork, UT
  • NPI 1679426944

  Hospital

  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • American Fork, UT
  • NPI 1912014358
  Care Compare affiliation
• Ihc Health Services, Inc.

  • Infusion Therapy Clinic/Center
  • American Fork, UT
  • NPI 1982557252

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1144497322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W STE 202",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-374-2367",
            "fax_number": "801-429-8015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1152 E 200 N",
            "address_purpose": "LOCATION",
            "city": "American Fork",
            "state": "UT",
            "postal_code": "840032004",
            "country_code": "US",
            "telephone_number": "801-374-2367",
            "fax_number": "801-429-8015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NUTTALL",
        "first_name": "MARC",
        "middle_name": "TRAVIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-15",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "6805182-1205",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "UT",
            "license": "68050182-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "1055 N 500 W Ste 202",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "endpointDescription": "CODING AUDIT",
            "affiliationName": "Revere Health PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1055 N 500 W Ste 202",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nova Counseling LLC
• Lillia Novero
• Now I Can Foundation
• Madison Nicole Nusca
• Brianna Renae Nuttall, CSW
• Ronald Brent Nuttall, A.T.C.
• Celia Nuzzo
• D. Alan Nybo, PT
• Kayla Nymeyer
• Hilary Rose O'Neil

• Hematology & Oncology Physician in Provo, UT
• Providers in Provo, UT by specialty
• Hematology & Oncology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.